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Clin Med II- Exam 2 > Pulmonary Dx Imaging > Flashcards

Pulmonary Dx Imaging Flashcards

1
Q

Imaging w/o radiation

A

U/s, MRI/MRA, Bronchoscopy

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2
Q

initial study for respiratory sx

A

CXR

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3
Q

What structures does CXR show

A

lung parenchyma, pleura, chest wall, diaphragm, mediastinum, hilum

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4
Q

Color of CXR

A 
gas = black
fat = dark gray
soft tissue = light gray
bone calcification = nearly white
metal = white
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5
Q

Indications for CXE

A 
SOB
persistent cough
hemoptysis
chest pain/injury
fever
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6
Q

CXR views

A

PA, AP, lateral, decubitus (PA and lateral are main ones; AP only done when patient can’t get out of bed – makes structures look bigger than they actually are)

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7
Q

ABCDEF’s of CXR

A 
Airway
Bone
Cardiac
Diaphragm
Edges
Fields of lungs
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8
Q

Lateral view CXR

A

good for seeing lower lobes

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9
Q

apical lordotic view use

A

seeing something in apex of lung (ex. TB)

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10
Q

PA and lateral decubitus CXR use

A

determine pus vs. fluid (fluid moves b/c it is free flowing) – subpulmonic effusion

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11
Q

Benefits of CXR

A 
non-invasive
low radiation
inexpensive
convenient
widely available
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12
Q

Pulmonary infarct

A

“Hampton’s hump”

triangular shape w/ base along chest wall; clot causes loss of circultation in lung leading to infarct

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13
Q

Risks/limitations of CXR

A

radiation exposure
pregnancy
can’t detect some conditions (small cancers, pulmonary emboli)

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14
Q

Why order a CT?

A 
clarify abnormal CXR
dx clinical sx (SOB, cough, CP, fever)
characterize pulmonary nodules
detect and stage primary and metastatic neoplasms
lung cancer screening
evaluate mediastinal or hilar masses
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15
Q

Lung cancer screening

A

55-80 yo w/ 30 pack/yr hx and currently smoke OR quit w/i past 15 years

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16
Q

Types of CT scans

A 
conventional
helical
high resolution (HRCT)
low dose CT
CT angiography
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17
Q

conventional CT

A

10 mm slice

“step and shoot”; 25-30 min

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18
Q

Helical CT

A

aka spiral CT
faster
continuous
<5 min

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19
Q

HRCT

A

better detail, 1 mm slice

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20
Q

Low dose CT

A

used for screening, less detail

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21
Q

Multidetector/multislice CT

A

64 x faster, but higher radiation

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22
Q

Benefits of CT

A 
fast, widely available
detailed images
real-time imaging for bx
can be performed w/ implanted device
less expensive and sensitive to movement than MRI
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23
Q

Risk/limitations of CT

A 
Radiation exposure
increased CA risk
fetal exposure during pregnancy
contrast issues
body habitus >450 lbs
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24
Q

Special populations for CT

A

peds: more radiosensitive, increased risk of leukemia and brain tumors
pregos: in utero exposure linked to ped CA mortality (always ask LMP before imaging)

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25
Q

CT contrast

A

iodine

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26
Q

Goal of contrast

A

enhance differences in densities of various structures

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27
Q

When to use contrast?

A

masses, CA, metastatic, obstructive processes, PE or dissection

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28
Q

Non-contrast use

A

eval of diffuse lung disease (HRCT)

follow up of primary nodules

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29
Q

Risk of CT w/ contrast

A

allergic rxn
contrast induced nephropathy
lactic acidosis if taking glucophage (metformin) – hold 48 hrs after imaging

30
Q

Allergic rxn from contrast

A

develops 5-60 min after

flushing, pruritus, urticaria, angioedema, bronchospasm, and wheezing, stridor, HTN, loss of consciousness

31
Q

Risk factor for allergic rxn to contrast

A

prior rxn
asthma
atopy

32
Q

How to avoid contrast rxn

A

pre-treat w/:

Prednisone & Diphenhydramine (Benadryl)

33
Q

Contrast induced nephropathy

A

serum Cr >25% from baseline or >0.5 mg/dL

usually reversible

Caution using contrast in pts w/ impaired kidney function

34
Q

Impaired kidney function considered

A

Cr >1.5 or GFR <60

35
Q

When to check renal function before iodine contrast

A 
age >60
hx of renal disease  (dialysis, single kidney, kidney transplant, renal cancer, renal surgery)
HTN treated w/ meds
DM
Glucophage (metformin)
36
Q

Glucophage

A

eGFR >30 - med doesn’t need to be withheld

AKI or severe CKD w/ eGFR <30 - hold metformin x 48 hrs; resume after eval of renal funciton (avoiding lactic acidosis)

37
Q

Pulmonary Angiography types

A

CTA or direct pulmonary angiography (catheter into patients)

38
Q

Angiography use

A

assess vasculature; done w/ CT, MRI or X-ray (direct)

39
Q

CTA

A

blood vessel detail; used for suspected PE, aortic dissection , SVC syndrome

identify vascular malformations

assess pulmonary arterial invasion by neoplasm

40
Q

CTPA benefits

A

less invasive than direct
precise anatomical guidance if surgery warranted
safer than conventional angiography

41
Q

Risks/limitations of CTPA

A 
can miss sub-segmental PES
allergy to contrast
nephrotoxicity
radiation
body habitus >450 lbs
42
Q

Gold standard for PE

A

direct pulmonary angiography

43
Q

What is direct pulmonary angiography?

A

needle/catheter inserted into right femoral or internal jugular vein –> R side heart –> pulm arteries

dye injected, x-rays taken

44
Q

When do you use direct pulmonary angiography

A

if V/Q or CTPA inconclusive but still have high clinical suspicion

45
Q

Risk of direct pulmonary angiography

A 
bleeding/hematoma at insertion site
heart arrhythmia
allergic rxn to contrast
impaired kidney function
radiation
46
Q

MRI use

A

limited in pulm disease

hilar or mediastinal densities, sulcus tumors, cysts, lesions of chest wall

if patient has allergy to iodine or renal disease (GFR <60)

47
Q

Benefits of MRI

A

no bone artifact as w/ CT

no radiation

48
Q

Contrast for MRI

A

gadolinium

49
Q

Limitations of MRI/MRA

A

pt must remain still
clautrophobia
body habitus
risk of nephrogenic systemic fibrosis (irreversible) - avoid gadolinium if GF <30 ml/min

50
Q

Contraindications of MRI/MRA

A

pacemaker/defibrillator
metal in eye
aneurysm clip
cochlear implant

51
Q

Nuclear imaging types

A

VQ

PET scan

52
Q

VQ use

A

PE

pre-op assessment prior to lung resection

53
Q

VQ mismatch

A

imbalance of blood flow and ventilation

54
Q

V/Q scan phases

A

IV phase: tech-99m (labeled to human albumin) injected and follows blood flow (perfusion)

inhalation phase: radio-labeled xenon gas demonstrates distribution of ventilation

55
Q

Benefits of V/Q

A

allergic rxn to radiopharm is rare
low dose radiation
Test of choice for PE in pregnant women
useful in estimating postop reserve capacity for those undergoing lung resection

56
Q

TOC for PE in pregos

A

V/Q

57
Q

Limitations of V/Q scan

A

sensitive for PE, but poorly specific (high false positives)

best utilized in those w/ normal CXR
no absolute contraindications

58
Q

PET scan

A

physiologic images

radiation emitted from fluorodeoxyglucose (FDG)

59
Q

FDG

A

radioactive glucose

accumulates in tissues/organs w/ high metabolic activity (cancer cells)

60
Q

measurement of PET scan

A

SUV >2.5 raises probability of malignancy

61
Q

Use of PET scan

A

detect cancer
metastasis
examine effects of cancer therapy

62
Q

Benefits of PET scan

A

detect changes in anatomy before apparent w/ CT and MRI

radioactivity is short-lived

63
Q

Limitations of PET scan

A

radiation
false + (inflammatory lesions, granulomas)
false - w/ slow growing tumors
time sensitive - radioactive substance decays quickly
high cost

64
Q

Indications for U/S

A

bedside detection of pleural fluid or pneumothorax
guidance for thoracentesis
guidance for placement of thoracostomy tubes

65
Q

Benefits of u/s

A

no radiation

portable units

66
Q

u/s of normal lung

A

seashore sign

67
Q

barcode or stratosphere sign

A

pneumothorax (no motion lung)

68
Q

Broncoscopy indications

A 
pneumonia, hemoptysis, cough
dx tracheoesophageal fistulas and tracheobronchomalacia
tissue sampling
removal of excess mucus or FBs
ET tube placement
69
Q

Rigid bronchoscopy

A

used for pts w/ obstruction of trachea or a proximal bronchus; for removal of debris (FB)

70
Q

Benefits of bronchoscopy

A 
safe
low complications (nasal discomfort, sore throat, mild hemoptysis; hemorrhage, pneumothorax, Hypotension, arrhythmia)
71
Q

Contraindications for bronchscopy

A

severe refractory hypoxia
risk of bleeding (anticoagulants, coagulopathy)
risk of respiratory and CV decompensation (asthma or COPD exacerbation current or recent MI, poorly controlled CHF, life threatening arrhythmias)

Clin Med II- Exam 2 (7 decks)

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